Dental code – loose implant screw

Often a loose screw can be a bit nerve racking for us dentists. Is it just the screw? We hope so!! If the implant is loose, it’s obviously a much bigger problem. To find out for sure we may need to drill through the crown and access the screw hole. Drilling a hole through a crown with any porcelain is going to increase chances of parts or all of the crown fracturing. There is also the very real risk of destroying the entire crown, because we are guessing where the screw access is. If the implant is in an ideal position then it’s not too bad to find, but without taking a CBCT we can’t be sure if that is the case. Discussing the possibility of the need for crown replacement, especially on a front tooth, is critical.

Finally, there is a risk that something is broken. A broken abutment requires replacement of the abutment and crown. If the implant head itself is damaged, the implant may be useless. A broken screw just needs a new screw BUT can be very tough/impossible to get out. Also a loose screw/crown will cause bone loss that looks similar to cement sepsis, so don’t be too surprised to see that as well.

This shows a screw access that is basically right in the middle, making it easier to find.

Once we access and find the screw successfully, we have two choices. Re-tighten the existing screw or replace the screw. Replacing the screw is far superior as a loose screw has been getting flexed and is more likely to fracture in future. Dental codes that we can use for a loose screw are

D6080 – Implant maintenance procedure where you remove and reinsert the prostheses, this includes cleaning of prosthesis and/or abutment.

D6199 – Unspecified implant procedure is what I try first. Curious as to the success others have had with submitting this code.

Charge a PA and limited exam and/or palliative care – Insurance will pay but not nearly enough for your time and materials.

There are some other codes you can use if there is cement on the crown or peri-implantitis present. If you are looking for codes for cement sepsis or minor cleaning click the link.

Should you replace a loose screw?

In the perfect world you would replace the screw. I would recommend doing this. You can re-tighten the existing screw but you should plan on replacing it soon.

How much should you charge to replace screw or re-tighten loose dental screw?

If this is yours and new, don’t charge anything and check your occlusion especially lateral movements. The fee if it is not yours or has been in for awhile is going to vary. I feel the fee should be about the same cost as your fee to re-cement a crown and do an occlusal composite plus some value for the risk take of touching the implant. That value is zero if it’s your crown. If the implant is not yours then make up a number. I charge between $400-500 based on how risky I think the situation is and also may or may not charge out a PA and limited oral exam.

D6199 or D6080 and charge about $400 plus cost of new screw if applicable

D0140 Whatever you charge

D0220 Whatever you charge

Bottom line

If this is one of yours and is fairly new, don’t bother charging more than a PA and maybe exam (again check occlusion – especially lateral movements). If NP or not your implant, probably not worth messing with unless you make very clear all the things that can go wrong AND you are familiar with the implant system. You can use the what implant is that website to ID the dental implant and then order a new screw.